Faculty Oversight Research Articles

An Analysis of Global Surgery Opportunities in American Otolaryngology Residency Programs.

To depict the current state of global surgery opportunities in United States ACGME-approved Otolaryngology residency programs and compare the characteristics of programs with and without these opportunities. In this cross-sectional analysis, websites of ACGME-accredited Otolaryngology residency programs were analyzed for information on program size, rank, age, and geographic region as obtained through the Doximity platform in 2023. Additional parameters were obtained for programs listing global surgery opportunities such as funding, faculty oversight, location/region, focus, and relationship to the community served. Data were tabulated and analyzed in Microsoft Excel and Stata. Of the 131 ACGME-accredited Otolaryngology residency programs, 26 (20%) of programs advertised a global surgery opportunity. Nine (35%) of these promoted funding, 15 (58%) offered a clinical focus, one (4%) offered a research focus, and 10 (38%) offered a combined approach. The Midwest region had the most programs with global surgery opportunities (n = 8, 31%). Less than half (42%) of programs had an established partnership with local partners within low and middle-income countries (LMICs). When comparing programs, the average Doximity rank, average program age, and average program size of programs that offered global surgery opportunities was significantly higher than those that did not (37.2 vs. 71.5, 54 vs. 41, 19.5 vs. 13.7; all p < 0.05). Approximately one-fifth of Otolaryngology training programs have a global surgery opportunity. Programs that offer these opportunities had a higher Doximity ranking, older program age, and a larger trainee cohort. These results highlight potential areas for expanding global surgery opportunities in academic institutions. NA Laryngoscope, 134:4501-4505, 2024.

Performance of ChatGPT on the India Undergraduate Community Medicine Examination: Cross-Sectional Study.

Medical students may increasingly use large language models (LLMs) in their learning. ChatGPT is an LLM at the forefront of this new development in medical education with the capacity to respond to multidisciplinary questions. The aim of this study was to evaluate the ability of ChatGPT 3.5 to complete the Indian undergraduate medical examination in the subject of community medicine. We further compared ChatGPT scores with the scores obtained by the students. The study was conducted at a publicly funded medical college in Hyderabad, India. The study was based on the internal assessment examination conducted in January 2023 for students in the Bachelor of Medicine and Bachelor of Surgery Final Year-Part I program; the examination of focus included 40 questions (divided between two papers) from the community medicine subject syllabus. Each paper had three sections with different weightage of marks for each section: section one had two long essay-type questions worth 15 marks each, section two had 8 short essay-type questions worth 5 marks each, and section three had 10 short-answer questions worth 3 marks each. The same questions were administered as prompts to ChatGPT 3.5 and the responses were recorded. Apart from scoring ChatGPT responses, two independent evaluators explored the responses to each question to further analyze their quality with regard to three subdomains: relevancy, coherence, and completeness. Each question was scored in these subdomains on a Likert scale of 1-5. The average of the two evaluators was taken as the subdomain score of the question. The proportion of questions with a score 50% of the maximum score (5) in each subdomain was calculated. ChatGPT 3.5 scored 72.3% on paper 1 and 61% on paper 2. The mean score of the 94 students was 43% on paper 1 and 45% on paper 2. The responses of ChatGPT 3.5 were also rated to be satisfactorily relevant, coherent, and complete for most of the questions (>80%). ChatGPT 3.5 appears to have substantial and sufficient knowledge to understand and answer the Indian medical undergraduate examination in the subject of community medicine. ChatGPT may be introduced to students to enable the self-directed learning of community medicine in pilot mode. However, faculty oversight will be required as ChatGPT is still in the initial stages of development, and thus its potential and reliability of medical content from the Indian context need to be further explored comprehensively.

LGBTQI+ representation in pre-licensure nursing textbooks: A qualitative descriptive analysis

BackgroundTo improve health equity, nursing curricula should include content specific to the needs of marginalized and underserved communities, such as lesbian, gay, bisexual, transgender, queer, and intersex groups (LGBTQI+). Harmful and absent academic discussions of LGBTQI+ patients lead to provider discomfort and inadequacy in treating this patient population. Nursing schools are well-positioned to increase comfort with LGBTQI+ content as part of pre-licensure curricula. This article presents a systematic evaluation of LGBTQI+ content in nursing pre-licensure textbooks and the nature and quality of the representations. MethodsA qualitative descriptive analysis of LGBTQI+ content from 14 nursing-specific textbooks required by a pre-licensure degree program at the Johns Hopkins School of Nursing was conducted by a student-led team with faculty oversight. A priori and iterative search terms were used to identify and extract text segments that referenced LGBTQI+ content in each textbook. An iterative codebook was developed, codes were applied, and analysis of the information and context in which the terms were presented was performed. ResultsThe research team observed gaps and notable patterns in distribution of LGBTQI+ terms and health content areas across the textbooks reviewed. The majority of LGBTQI+ search terms were identified in the following health content areas: social determinants of health, sexual/reproductive health, pediatric sexual & gender diversity, intersectionality, and infectious disease. Based on qualitative descriptive analyses, the data were organized into the following categories: a) Language; b) Medicalization; c) Vague, Incomplete, or Lacking Specificity; and d) Comprehensive Approach. ConclusionFindings highlight the need for increased academic exposure for pre-licensure nursing students regarding the care of LGBTQI+ patients. Thoughtful inclusion of LGBTQI+ content may better foster the delivery of evidence-based care for this patient population. These findings underscore the need for improved nursing curricula to support nurses in delivering affirming care for LGBTQI+ populations.

Separate But Not Equal? A Cross-Sectional Study of Segregation by Payor Mix in Academic Primary Care Clinics.

At some US Academic Health Centers (AHCs), patients with predominantly Medicaid insurance are seen in one clinic and patients with other insurance are seen in another. The extent of this practice and implications are unknown. To estimate the proportion of AHCs that have at least two primary care internal medicine clinics that differ substantially in proportion of patients with Medicaid and to compare patient demographic, staffing, and operational features. General internal medicine chiefs and clinic directors at 40 randomly selected US AHCs plus the top 10 AHCs in terms of NIH funding. An AHC was classified as maintaining clinics that differed substantially in the proportion of patients with Medicaid if any two differed by ≥ 40% (absolute). Other criteria were used for pre-specified secondary analyses (e.g., ≥ 30%). Thirty-nine of 50 AHCs (78%) participated. Four of 39 (10%; 95% CI, 3 to 24%) had two clinics differing by ≥ 40% in the proportion of patients with Medicaid, eight (21%; 95% CI, 9 to 36%) had clinics differing by ≥ 30%, and 15 (38%; 95% CI, 23 to 55%) had clinics differing by ≥ 20%. Clinics with more patients with Medicaid by any of the three criteria were more likely to employ resident physicians as providers of longitudinal care (with faculty supervision) and more likely to have patients who were Black or Hispanic. Some US AHCs maintain separate clinics defined by the proportion of patients with Medicaid. Clinics with a higher proportion of patients insured by Medicaid are more likely to employ residents (with faculty oversight), feature residents as providers of longitudinal care, and serve patients who are Black and Hispanic. Further research is needed to understand why some AHCs have primary care clinics distinguishable by insurance mix with the goal of ensuring that racism and discrimination are not root causes.

A Novel Hands-on Approach Towards Teaching Diagnostic Radiology Residents MRI Scanning and Physics

Traditional approaches towards teaching magnetic resonance imaging (MRI) scanning and physics have limitations that a hands-on course may help overcome. A dedicated week of MRI instruction may help improve radiology resident confidence and competence. Additional benefits may include improved physician-technologist communication and accelerated mastery of MRI safety. Surveys and tests were approved by our Program Evaluation Committee and administered at the beginning and at the end of this one-week course. The course consisted of protected reading time as well as practice scanning with a research magnet and assisting with clinical scanning under the close supervision of a licensed MRI technologist. Eighteen senior residents (nine third-year and nine fourth-year) participated in this course during its first year. Few residents had previous experience with MRI physics, scanning, or research prior to residency. After this course, mean resident confidence increased by 0.47 points (3.33 vs 2.86; p=0.01) on a five-point Likert scale. Understanding of MRI physics, as measured by pre- and post-tests, increased by 22% (0.72 vs 0.50; p<0.01), corresponding to a large effect size of 1.29 (p<0.001). Resident feedback reported that this course was efficacious (5/5), engaging (4.9/5), and had optimal faculty oversight. The most highly rated component of the course was the opportunity to experiment with the research MR scanner (5/5). A dedicated week of MRI education was highly rated by residents and associated with improvements in confidence and understanding, suggesting a positive correlation between confidence and competence. Additional metrics, such as trends in scores on the American Board of Radiology's Core Examination over the next several years, may further support the apparent benefits of this hands-on MR course.

Development of Competencies in Oral and Maxillofacial Surgery Training.

The goal of graduate surgical education is to ensure that the graduate is competent to practice in his or her chosen specialty. Traditionally, surgical learning has been based on an apprenticeship model; that is, the long-term observation and assessment of the trainee over a prolonged period of time. Patient expectations, work hour restrictions, and expectations of increased faculty oversight have led to decreased resident autonomy and independence. Graduates completing surgical training with less surgical autonomy may have lower clinical competence, which may affect patient safety, patient outcomes, and career satisfaction. This will require the modification of current assessment and training methods.

144 Foundations of Emergency Medicine Resident as Teacher Experience

144 Foundations of Emergency Medicine Resident as Teacher Experience

Transition to wellness: developing a telehealth wellness program to address student fieldwork challenges during the COVID-19 pandemic.

The Transition to Wellness Program is an occupational therapy (OT) based program that was developed in response to the COVID-19 pandemic. For OT students, fieldwork is a required element of their training. In March 2020, these were being halted due to lockdowns and the risk to students in healthcare settings. Facing significant delays to graduation for 60 students, including some unable to be placed into healthcare settings due to underlying conditions, the development of a telehealth program was conceived to address this, while still meeting the accreditation clinical/health/wellness standards for OT fieldwork. A group of students, with faculty oversight, developed the theoretical basis, tools, policies and procedures for the program. An incremental launch allowed testing and refinement of the program to meet the educational needs of the students and the wellness needs of the clients. At its launch, the program supported 10 of that cohorts’ 60 students to continue to meet the required academic standards and progress through their fieldwork towards graduation. Each student got to experience the “telehealth” model in providing OT wellness interventions to individuals in the local community. Future work will focus on continuing to broaden the reach of the program and measure the outcomes.

Discussion

Discussion

The Effect of Advanced Practice Providers on ACGME Colon and Rectal Surgery Resident Diagnostic Index Case Volumes

Prior to 2015 residents in our Accreditation Council for Graduation Medical Education (ACGME) colon and rectal surgery training program were in charge of managing, with faculty oversight, the outpatient anorectal clinic at our institution. Starting in 2015 advanced practice providers (APPs) working in the division assumed management of the clinic. The effect of APPs on ACGME resident index diagnostic case volumes has not been explored. Herein we examine ACGME case log graduate statistics to determine if the inclusion of APPs into our anorectal clinic practice has negatively affected resident index diagnostic anorectal case volumes. ACGME year-end program reports were obtained for the years 2011 to 2019. Program anorectal diagnostic index volumes were recorded and compared to division volumes. Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) tests were conducted to assess whether the number of cases per year (for each respective case type) prior to the introduction of APPs into the anorectal clinic (2011-2014) differed from the number of cases per year with the APP clinic in place (2015-2018). A p-value <0.05 was considered statistically significant. Mayo Clinic, Rochester, Minnesota (quaternary referral center). Colon and rectal surgery resident year-end ACGME reports (2011-2019). ANOVAs revealed a marginally significant (p = 0.007) downtrend for hemorrhoid diagnostic codes, and a significant uptrend (p = 0.000) for fistula cases. Controlling for overall division volume, ANCOVA only reveled significance for fistula cases (p = 0.004) with the involvement of APPs. At our institution we found the inclusion of APPs into our anorectal clinic practice did not negatively affect colon and rectal surgery resident ACGME index diagnostic anorectal case volumes. Inclusion of APPs into a multidisciplinary practice can promote resident education by allowing trainees to pursue other educational opportunities without hindering ACGME index case volumes.

Training Experiences of American Society of Transplant Surgeons Fellows in Deceased Donor Organ Procurement.

Training Experiences of American Society of Transplant Surgeons Fellows in Deceased Donor Organ Procurement.

Student, Faculty, and Graduate Teaching Assistant Perceptions of Support Provided by a Graduate Student Writing Centre

The purpose of this mixed-methods study was to identify key factors in a discipline-specific, self-access graduate writing centre that both contribute to student success and that indicate needed improvements. The centre is located in a graduate education program at a university in Canada. Findings indicate the centre contributes to student success most directly by helping students improve their writing, which leads to an overall sense of confidence and engagement. Relationships with other students were also enhanced and found to be important. Faculty similarly noted that the improvements in writing and the strengthening of the graduate student culture were important gains. Graduate teaching assistants working in the centre said they benefited from improvements with their writing, which they linked to supporting students, as well as personal gains in their instructional skills. Suggested improvements included increasing appointment availability, adding workshops on new topics, increasing the availability of workshops and events, and increasing interaction between students and faculty at social events. These results indicate that providing targeted supports led by students but guided by faculty input and oversight can increase graduate student success and benefit graduate programs in general.

Increasing the Educational Value of the Orthopaedic Subinternship: The Design and Implementation of a Fourth-Year Medical Student Curriculum.

Introduction:Most orthopaedic subinternships function as month-long interviews. These rotations remain relatively unstructured and lack standardization, and their overall educational value has been called into question. The goals of this educational initiative were to create a structured subinternship curriculum for orthopaedic applicants and to shift the focus of the subinternship from a month-long interview to an organized educational experience.Methods:After review of knowledge and skills expected for early orthopaedic residency under the structure of the Accreditation Council for Graduate Medical Education Milestones, a curriculum dedicated to orthopaedic subinternships was created. Students who completed the curriculum filled out anonymous Likert scale evaluations (rating their comfort/knowledge from 0 to 10 before and after their rotation) and answered open-ended qualitative questions.Results:Forty-six subinterns participated in the program over 3 years. Four weekly learning modules were designed and taught by orthopaedic residents, with faculty oversight of content and structure. Each monthly rotation began with an orthopaedic surgical skills laboratory and concluded with a case-based oral presentation. Weeks two and three covered different milestone-based topics and included didactic and skills development. Data analysis revealed that students reported notable improvement in knowledge and familiarity with each of the topics. The greatest improvements were in tibia intramedullary nailing and applying a tension band to an olecranon fracture. When asked which surgical skills station was the most helpful, 70% chose lag screw insertion and basic plating techniques. All students felt that creating their case presentation was productive.Conclusion:This educational initiative resulted in the successful design and implementation of a milestone-based orthopaedic surgery subinternship curriculum. The program was well received by students, contributed to learning and competency, and provided teaching opportunities for residents. The format and content of this subinternship curriculum can easily be adapted to regional and national teaching programs.

Carle Illinois College of Medicine.

Carle Illinois College of Medicine.

Abstract D005: Outcomes of a cancer research fellowship program for underrepresented high school students

Abstract Introduction: Minority populations and individuals from socioeconomically disadvantaged backgrounds suffer from high rates of cancer, yet these at-risk communities are underrepresented in the biomedical research and clinical workforce. Disparities start from an early age and stem from multiple factors, though gaps in education play a role. In the summer of 2018, University of California San Diego (UCSD) created a cancer research fellowship program for minority high school students called Outreach Program to Inspire Minority and Underrepresented Students (OPTIMUS). This report presents early outcomes of the inaugural cohort of OPTIMUS scholars. Methods: The OPTIMUS program recruits students from four underserved public high schools in southeast San Diego. Selected students (OPTIMUS scholars) are provided transportation to Moores Cancer Center at UCSD daily for a 6-week paid summer internship. Each OPTIMUS scholar is paired with a supportive cancer research lab for a mentored-lab experience. In parallel to the lab experience, scholars participate in a cancer research education curriculum, clinical shadowing, and other endeavors including college preparatory activities and social networking events. Under UCSD faculty oversight, the program is run by medical students, residents, and fellows. We surveyed students about their perceptions of different curricular elements during the program, and again 9-months after completion of the program. Results: OPTIMUS launched in July 2018, and received 132 complete applications, with applicants self-identifying as African American (28%), Hispanic (17%), Pacific Islander (32%), multiracial (10%), and other (13%). The majority of students came from socioeconomic disadvantaged households (61%) and had parents who did not attend college (66%). Ten OPTIMUS scholars were selected for the initial program, and completed all 6-weeks of the summer fellowship. Survey results indicated that students were “very satisfied” to “mostly satisfied” with the majority of the components of the program (scoring 3 or 4 on a 4 point satisfaction scale). The 5 high school seniors in our initial OPTIMUS cohort have each received acceptance letters from 4-year universities, and each plans to major in a biology-based or health science related field. Conclusions: The OPTIMUS cancer research fellowship has generated interest among local underrepresented students, and early outcomes show promising results with students successfully transitioning into university. Long term follow up of students will help to fully understand the impact of this program, though success with OPTIMUS and other programs focusing on strengthening the educational pipeline stand to help improve diversity in the oncology workforce. Citation Format: Ekenechukwu A Akabike, Alexa Azuara, Elena S Heide, Cristal Vieyra, Nicolas Villanueva, Daniel M Seible, James D Murphy. Outcomes of a cancer research fellowship program for underrepresented high school students [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D005.

Human subjects research as part of immunology education

Abstract Original research has been identified as a high impact practice in undergraduate education – students who participate have been shown to be more likely to be be successful in professional and academic graduate programs. Course-embedded research allows for students to tie laboratory experiences to classroom concepts and allows for many students to benefit from faculty oversight. Undergraduate research in immunology presents challenges because most models of immunology are limited to vertebrate organisms, which require additional regulatory oversight from Institutional Animal Care and Use Committees or Institutional Review Boards. One common solution is to limit student interaction with organisms by using isolated or cultured cells, however this prevents students from gaining a realistic understanding of all the stages of immunological research. Obtaining authorization for student-designed research, conducting the projects, and analyzing and presenting the results within a single semester is a daunting proposal, one which has been further complicated by the full implementation of the new Common Rule for human subjects research. We have developed a model for conducting human subjects research within a single semester of a junior-level undergraduate immunology course. By using a framework protocol, non-invasive sampling, and anonymized presented data we are able to work within IRB/IACUC regulations beyond the classroom exercise level, allowing students to share their findings with the broader campus community, in online portfolios, and at professional conferences. This model has been sustainable for five years at a public primarily undergraduate institution and has been successful under the new common rule regulations.

Abstract 261: Improving Hypertension Control Among an Underserved Urban Patient Population

Needs and Objectives: Poorly-controlled hypertension is associated with increased risk of adverse cardiovascular outcomes and thus is an important healthcare quality metric for primary care practices. Yet achieving blood pressure goals among socially-complex, economically-disadvantaged patient populations can be challenging due to cost-related non-adherence, poor health literacy and other social determinant barriers. Indeed, by early 2019, only 59% of hypertensive patients at our inner-city community health clinic had a blood pressure less than 140/90. The goal of this resident-driven quality improvement (QI) project was to increase blood pressure control among our hypertensive patients to a network target of 75% over 6 months. Setting and Participants: Our project was implemented at the Ryan Adair Center, a Federally Qualified Health Center located in Central Harlem that serves as a primary care practice site for Internal Medicine residents. The patient population consists predominantly of Black and Latino patients, most of whom are on Medicaid and live well below the federal poverty line. Our target population was hypertensive patients. Intervention: We used the Plan-Do-Study-Act method to carry out our clinic-based project. PGY1’s at the site served as the QI project leaders with faculty oversight. Cycle 1 focused on nurse education regarding proper blood pressure measurement. Cycle 2 focused on home blood pressure monitoring including patient education on proper technique and the importance of maintaining a daily log. Cycle 3 focused on assessment of health literacy via a patient questionnaire. Cycle 4 focused on provider education by ensuring that our patients were prescribed an appropriate medication regimen based on ACC/AHA Guidelines. Cycle 5 focused on referring patients with continued poor control to community health coaches to identify barriers like nutrition, medication access, and health literacy. Evaluation: Using our clinic’s online hypertensive registry (DRVS), we tracked on a monthly basis the percentage of hypertensive patients who had controlled blood pressure (&lt;140/90). Percent of patients at goal went from 59% in February 2019 to 73% in July 2019. Discussion/lessons learned: Through this project, we demonstrated a meaningful improvement in hypertensive control among an economically-disadvantaged, racially diverse urban patient population. Accurate nurse measurements, engagement of patients in self-management, and resident education on evidence-based medication standards have all contributed to this success. Future directions will explore the impact of community health coaches in hypertension control and use of standard questionnaire to assess health literacy.

Cost analysis and barriers to implementing and sustaining an international surgical resident rotation: a retrospective review

BackgroundThe overwhelming need and interest in global surgery has led to increasing numbers of international surgery resident rotations. Despite the validity of global surgical education, financial and logistical barriers remain when implementing these international rotations. The Mount Sinai Department of Surgery, New York, USA, established an international resident rotation in 2005. Here, we describe some of the costs and barriers to establishing and maintaining a global surgery rotation with the aim of providing a guideline for academic institutions interested in building an international rotation. MethodsThis study is a retrospective review of the international rotation with the Hospital Jose Maria Cabral y Báez (Cabral) in Santiago, Dominican Republic. The exchange programme is an opportunity for two resident doctors from Dominican Republic to join Mount Sinai third year residents in a 1-month surgical rotation. We reviewed data collected from budgets, financial investments, resident and programme director experiences, and formal agreements between the two institutions. FindingsWith the Mount Sinai funding, there have been three residents from the Dominican Republic who have completed an exchange rotation at the Mount Sinai Hospital. An optimum international site requires a balanced alliance between the US academic institution and the international site. The Cabral and Mount Sinai collaborative partnership allows residents from both institutions to benefit from the exchange of experiences and surgical practices. Site selection is contingent on: hospital infrastructure (eg, operative variety and volume, faculty oversight); suitable living accommodations that allow personal safety, access to food, running water, electricity, and an internet connection; and overcoming language barriers. Successful implementation requires a time commitment from staff at both institutions. The monthly operational cost of this programme is US$3530, with 37% for visiting resident accommodation, 30% for transport, 20% for visiting resident expenses, and 13% for health and communication expenses. The time required by the US programme director includes an annual trip to the international rotation site and approximately 100 h per year, which includes monthly orientations and debriefings, and research. Finally, this programme requires adherence to Accreditation Council for Graduate Medical Education and Residency Review Committee guidelines. InterpretationGlobal academic surgery combines surgery with education, clinical service, research, and advocacy in resource-limited settings. Mitigation of logistical barriers and addressing financial costs allows for successful global academic surgery programmes. FundingNone

Teaching and learning FNA biopsy: An update for the modern audience

Teaching and learning FNA biopsy: An update for the modern audience

Formative Assessment of Performance in Diagnostic Ultrasound Using Simulation and Quantitative and Objective Metrics.

We developed simulator-based tools for assessing provider competence in transthoracic echocardiography (TTE) and vascular duplex scanning. Psychomotor (technical) skill in TTE image acquisition was calculated from the deviation angle of an acquired image from the anatomically correct view. We applied this metric for formative assessment to give feedback to learners and evaluate curricula.Psychomotor skill in vascular ultrasound was measured in terms of dexterity and image plane location; cognitive skill was assessed from measurements of blood flow velocity, parameter settings, and diagnosis. The validity of the vascular simulator was assessed from the accuracy with which experts can measure peak systolic blood flow velocity (PSV). In the TTE simulator, the skill metric enabled immediate feedback, formative assessment of curriculum efficacy, and comparison of curriculum outcomes. The vascular duplex ultrasound simulator also provided feedback, and experts' measurements of PSV deviated from actual PSV in the model by <10%. Skill in acquiring diagnostic ultrasound images of organs and vessels can be measured using simulation in an objective, quantitative, and standardized manner. Current applications are provision of feedback to learners to enable training without direct faculty oversight and formative assessment of curricula. Simulator-based metrics could also be applied for summative assessment.